Since 2014, Licensed Behavior Analysts (LBA) have been providing services to Medicaid recipients (under 21) under their licenses issued by the Department of Health Professions (per 12VAC35-105-20, the definition of “Provider”) rather than a specific license from DBHDS. This works well for those providing services based in Applied Behavior Analysis (ABA) in the individual’s home or the community. However, when the LBA owns a clinic, it is difficult to determine which rules and regulations to follow for the building itself and services provided in the building. For instance, there is nothing dictating how many hours a day the child can be receiving services at the clinic, or anything regulating how hot the water can be. There are licenses offered by the Department of Education and the Department of Social Services that do not align with the services typically delivered by LBAs. Therefore, to best serve the individuals receiving ABA services in a clinic setting, I respectfully ask that DBHDS bring back the Outpatient ABA license.

This issue may be resolved by added the definition of Applied Behavior Analysis (ABA) into the definitions and adding the following as #4 under

“Outpatient service.”
4. Applied Behavior Analysis (ABA) services provided in a clinic setting in accordance with the provisions of 18VAC85-150-10 et seq. to children under 18 years of age when no parent or caretaker is present. The ABA outpatient clinic provider assumes all responsibility for the care of the child or person over the age of 18 who has a legal guardian who is attending the clinic without the presence of a caregiver.

In addition, currently, LBAs are delivering services through Behavioral Therapy. This service does not completely align with how services based in ABA should be practiced and some abuses stem from the forced fit including inadequate supervision and the assignment of tasks to non-licensed persons that should be completed by licensed persons. Adding ABA to the definitions in these regulations and assigning it as an outpatient service would assist in safeguarding individuals who receive the service. In addition, it would be imperative to tier the rates that LBAs, LABAs (Licensed Assistant Behavior Analysts), and unlicensed persons (such as Registered Behavior Technicians – RBTs) receive.

Thank you for your consideration.

Nikia Dower, MS, CCC-SLP, BCBA, LBA

Dower and Associates, Inc.